Provider Demographics
NPI:1972665610
Name:PATTI, JACQUELYN STAR (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:STAR
Last Name:PATTI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W166N10209 CALICO LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4742
Mailing Address - Country:US
Mailing Address - Phone:262-251-5496
Mailing Address - Fax:
Practice Address - Street 1:W166N10209 CALICO LN
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4742
Practice Address - Country:US
Practice Address - Phone:262-251-5496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI76508-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health